ArticleMedicine2026
Vitamin D as a mediator in the J-shaped association between serum uric acid and all-cause and cardiovascular mortality in patients with cardiovascular-kidney-metabolic syndrome: A prospective cohort study.
Article in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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5 authors.
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Abstract
The relationship between serum uric acid (UA) and mortality in patients with cardiovascular-kidney-Metabolic (CKM) syndrome remains unclear. We hypothesized that elevated UA increases mortality nonlinearly and is partly mediated by vitamin D. Using NHANES data (2007-2016) from 25,979 adults with CKM stages 0 to 4, we performed Cox regression, threshold analysis, and causal mediation analysis. During a median follow-up of 93.0 months, 2264 all-cause and 689 cardiovascular deaths occurred. A J-shaped relationship existed between UA and mortality. Each 1 mg/dL increase in UA increased fully adjusted risks of all-cause (HR = 1.06, 95% CI: 1.02-1.09) and cardiovascular mortality (HR = 1.11, 95% CI: 1.04-1.18). Thresholds were identified at 6.6 mg/dL and 7.1 mg/dL. Participants aged ≤60 years showed higher all-cause mortality risk (HR = 1.15, 95% CI: 1.06-1.25). Serum 25(OH)D negatively correlated with UA (β = -0.064, P < .00001) and mediated 14.55% of its effect on all-cause mortality. High UA beyond specific thresholds predicts mortality in CKM syndrome, partially mediated by vitamin D. Interventions on UA and vitamin D may improve outcomes.
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